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| Item Number | Policy/Procedure Date Posted Comment Period Closed Status | Date Posted Comment Period Closed Status | Comment Period Closed Status | Status | Document Links |
|---|---|---|---|---|---|
| 2025-HB-MED-594 | Opdualag (nivolumab and relatlimab-rmbw) | 10/6/25 | 11/20/25 | Pending | Opdualag (nivolumab and relatlimab-rmbw) |
| 2025-HB-MED-595 | Zynlonta (loncastuximab tesirine-lpyl) | 10/6/25 | 11/20/25 | Pending | Zynlonta (loncastuximab tesirine-lpyl) |
| 2025-HB-MED-596 | Rybrevant (amivantamab-ymjw) | 10/6/25 | 11/20/25 | Pending | Rybrevant (amivantamab-ymjw) |
| 2025-HB-MED-597 | Jemperli (dostarlimab-gxly) | 10/6/25 | 11/20/25 | Pending | Jemperli (dostarlimab-gxly) |
| 2025-HB-MED-598 | Zepzelca (lurbinectedin) | 10/6/25 | 11/20/25 | Pending | Zepzelca (lurbinectedin) |
| 2025-HB-MED-599 | Ryplazim (plasminogen, human-tvmh) | 10/6/25 | 11/20/25 | Pending | Ryplazim (plasminogen, human-tvmh) |
| 2025-HB-MED-602 | Human Parathyroid Hormone | 10/6/25 | 11/20/25 | Pending | Human Parathyroid Hormone |
| 2025-LHCC-MED-866 | LInvoseltamab-gcpt (Lynozyfic) inject | 10/6/25 | 11/20/25 | Pending | LInvoseltamab-gcpt (Lynozyfic) inject |
| 2025-LHCC-MED-867 | Remestemcel-L-rknd (Ryoncil) | 10/6/25 | 11/20/25 | Pending | Remestemcel-L-rknd (Ryoncil) |
| 2025-LHCC-MED-868 | Encelto | 10/6/25 | 11/20/25 | Pending | Encelto |
| 2025-LHCC-MED-869 | Blinatumomab(Blincyto) | 10/6/25 | 11/20/25 | Pending | Blinatumomab(Blincyto) |
| 2025-LHCC-MED-870 | Eculizumab (Soliris), Eculizumab-aeeb (Bkemv), Eculizumab-aagh (Epysqli) | 10/6/25 | 11/20/25 | Pending | Eculizumab (Soliris), Eculizumab-aeeb (Bkemv), Eculizumab-aagh (Epysqli) |
| 2025-LHCC-MED-871 | Brentuximab Vedotin (Adcetris) | 10/6/25 | 11/20/25 | Pending | Brentuximab Vedotin (Adcetris) |
| 2025-UHC-MED-259 | Brineura | 9/29/25 | 11/13/25 | Pending | Brineura |
| 2025-UHC-MED-260 | FcRn-blockers | 9/29/25 | 11/13/25 | Pending | FcRn-blockers |
| 2025-PHARM-122 | Amvuttra | 9/26/25 | 11/10/25 | Pending | Amvuttra |
| 2025-PHARM-123 | Andembry | 9/26/25 | 11/10/25 | Pending | Andembry |
| 2025-PHARM-124 | Colony Stimulating Factors | 9/26/25 | 11/10/25 | Pending | Colony Stimulating Factors |
| 2025-PHARM-125 | Dermatology - Atopic Dermatitis, Immunomodulators | 9/26/25 | 11/10/25 | Pending | Dermatology - Atopic Dermatitis, Immunomodulators |
| 2025-PHARM-126 | Harliku | 9/26/25 | 11/10/25 | Pending | Harliku |
| 2025-PHARM-127 | Heart Disease - Hypertension, Beta Blockers | 9/26/25 | 11/10/25 | Pending | Heart Disease - Hypertension, Beta Blockers |
| 2025-PHARM-128 | Imuldosa | 9/26/25 | 11/10/25 | Pending | Imuldosa |
| 2025-PHARM-129 | Kerendia | 9/26/25 | 11/10/25 | Pending | Kerendia |
| 2025-PHARM-130 | Leqselvi | 9/26/25 | 11/10/25 | Pending | Leqselvi |
| 2025-PHARM-131 | Louisiana Medicaid ICD-10 Chart | 9/26/25 | 11/10/25 | Pending | Louisiana Medicaid ICD-10 Chart |
| 2025-PHARM-132 | Myalept | 9/26/25 | 11/10/25 | Pending | Myalept |
| 2025-PHARM-133 | Onpattro | 9/26/25 | 11/10/25 | Pending | Onpattro |
| 2025-PHARM-134 | Pain Management - Cytokine/CAM Antagonists | 9/26/25 | 11/10/25 | Pending | Pain Management - Cytokine/CAM Antagonists |
| 2025-PHARM-135 | POS Amvuttra | 9/26/25 | 11/10/25 | Pending | POS Amvuttra |
| 2025-PHARM-136 | POS Brynovin | 9/26/25 | 11/10/25 | Pending | POS Brynovin |
| 2025-PHARM-137 | POS Dermatology - Atopic Dermatitis, Immunomodulators | 9/26/25 | 11/10/25 | Pending | POS Dermatology - Atopic Dermatitis, Immunomodulators |
| 2025-PHARM-138 | POS Epysqli | 9/26/25 | 11/10/25 | Pending | POS Epysqli |
| 2025-PHARM-139 | POS Fabhalta | 9/26/25 | 11/10/25 | Pending | POS Fabhalta |
| 2025-PHARM-140 | POS GI Motility, Chronic | 9/26/25 | 11/10/25 | Pending | POS GI Motility, Chronic |
| 2025-PHARM-141 | POS Heart Disease - Hypertension, Beta Blocker Agents | 9/26/25 | 11/10/25 | Pending | POS Heart Disease - Hypertension, Beta Blocker Agents |
| 2025-PHARM-142 | POS Imaavy | 9/26/25 | 11/10/25 | Pending | POS Imaavy |
| 2025-PHARM-143 | POS Leqselvi | 9/26/25 | 11/10/25 | Pending | POS Leqselvi |
| 2025-PHARM-144 | POS Merilog | 9/26/25 | 11/10/25 | Pending | POS Merilog |
| 2025-PHARM-145 | POS Misoprostol | 9/26/25 | 11/10/25 | Pending | POS Misoprostol |
| 2025-PHARM-146 | POS Onpattro | 9/26/25 | 11/10/25 | Pending | POS Onpattro |
| 2025-PHARM-147 | POS Qfitlia | 9/26/25 | 11/10/25 | Pending | POS Qfitlia |
| 2025-PHARM-148 | POS Symbravo | 9/26/25 | 11/10/25 | Pending | POS Symbravo |
| 2025-PHARM-149 | POS Urology - Incontinence, Bladder Relaxant Preparations | 9/26/25 | 11/10/25 | Pending | POS Urology - Incontinence, Bladder Relaxant Preparations |
| 2025-PHARM-150 | POS Vanrafia | 9/26/25 | 11/10/25 | Pending | POS Vanrafia |
| 2025-PHARM-151 | POS Wainua | 9/26/25 | 11/10/25 | Pending | POS Wainua |
| 2025-PHARM-152 | POS Yutrepia | 9/26/25 | 11/10/25 | Pending | POS Yutrepia |
| 2025-PHARM-153 | POS Zelsuvmi | 9/26/25 | 11/10/25 | Pending | POS Zelsuvmi |
| 2025-PHARM-154 | POS Zepbound | 9/26/25 | 11/10/25 | Pending | POS Zepbound |
| 2025-PHARM-155 | Rivfloza | 9/26/25 | 11/10/25 | Pending | Rivfloza |
| 2025-PHARM-156 | Ryzneuta | 9/26/25 | 11/10/25 | Pending | Ryzneuta |
| 2025-PHARM-157 | Wainua | 9/26/25 | 11/10/25 | Pending | Wainua |
| 2025-PHARM-158 | Zepbound | 9/26/25 | 11/10/25 | Pending | Zepbound |
| 2025-PHARM-159 | Zepbound Patient Agreement | 9/26/25 | 11/10/25 | Pending | Zepbound Patient Agreement |
| 2025-PHARM-160 | Zevaskyn | 9/26/25 | 11/10/25 | Pending | Zevaskyn |
| 2025-HUM-MED-149 | Panitumumab (HUM 8505) | 9/25/25 | 11/9/25 | Pending | Panitumumab (HUM 8505) |
| 2025-HUM-MED-155 | Abatacept (HUM 8585) | 9/25/25 | 11/9/25 | Pending | Abatacept (HUM 8585) |
| 2025-HB-MED-583 | Keytruda (pembrolizumab) | 9/25/25 | 11/9/25 | Pending | Keytruda (pembrolizumab) |
| 2025-HB-MED-585 | Imcivree (setmelanotide) | 9/25/25 | 11/9/25 | Pending | Imcivree (setmelanotide) |
| 2025-HB-MED-587 | Tepezza (teprotumumab-trbw) | 9/25/25 | 11/9/25 | Pending | Tepezza (teprotumumab-trbw) |
| 2025-HB-MED-593 | Kisunla | 9/25/25 | 11/9/25 | Pending | Kisunla |
| 2025-HB-MED-572 | Opdivo (nivolumab) | 9/18/25 | 11/2/25 | Pending | Opdivo (nivolumab) |
| 2025-HB-MED-573 | Yervoy (ipilimumab) | 9/18/25 | 11/2/25 | Pending | Yervoy (ipilimumab) |
| 2025-HB-MED-574 | Opdivo Qvantig (nivolumab hyaluronidase-nvhy) | 9/18/25 | 11/2/25 | Pending | Opdivo Qvantig (nivolumab hyaluronidase-nvhy) |
| 2025-HB-MED-575 | Lunsumio (mosunetuzumab-axgb) | 9/18/25 | 11/2/25 | Pending | Lunsumio (mosunetuzumab-axgb) |
| 2025-HB-MED-576 | Tevimbra (tislelizumab-jsgr) | 9/18/25 | 11/2/25 | Pending | Tevimbra (tislelizumab-jsgr) |
| 2025-HB-MED-577 | Bizengri (zenocutuzumab-zbco) | 9/18/25 | 11/2/25 | Pending | Bizengri (zenocutuzumab-zbco) |
| 2025-HB-MED-578 | Pemetrexed | 9/18/25 | 11/2/25 | Pending | Pemetrexed |
| 2025-HB-MED-579 | Radioimmunotherapy and Somatostatin Receptor Targeted Radiotherapy (Azedra, Lutathera, Pluvicto, Zevalin) | 9/18/25 | 11/2/25 | Pending | Radioimmunotherapy and Somatostatin Receptor Targeted Radiotherapy (Azedra, Lutathera, Pluvicto, Zevalin) |
| 2025-HB-MED-580 | Anktiva (nogapendekin alfa inbakicept-pmln) | 9/18/25 | 11/2/25 | Pending | Anktiva (nogapendekin alfa inbakicept-pmln) |
| 2025-HB-MED-581 | Imdelltra (tarlatamab-dlle) | 9/18/25 | 11/2/25 | Pending | Imdelltra (tarlatamab-dlle) |
| 2025-HB-MED-562 | Synribo (omacetaxine mepesuccinate) | 9/18/25 | 11/2/25 | Pending | Synribo (omacetaxine mepesuccinate) |
| 2025-HB-MED-563 | Trastuzumab Agents | 9/18/25 | 11/2/25 | Pending | Trastuzumab Agents |
| 2025-HB-MED-564 | Jevtana (cabazitaxel) | 9/18/25 | 11/2/25 | Pending | Jevtana (cabazitaxel) |
| 2025-HB-MED-565 | Libtayo (cemiplimab-rwlc) | 9/18/25 | 11/2/25 | Pending | Libtayo (cemiplimab-rwlc) |
| 2025-HB-MED-566 | GNRH Analogs for Oncologic Indications | 9/18/25 | 11/2/25 | Pending | GNRH Analogs for Oncologic Indications |
| 2025-HB-MED-567 | Gamifant (emapalumab) | 9/18/25 | 11/2/25 | Pending | Gamifant (emapalumab) |
| 2025-HB-MED-568 | Rybrevant (amivantamab-ymjw) | 9/18/25 | 11/2/25 | Pending | Rybrevant (amivantamab-ymjw) |
| 2025-HB-MED-569 | Phesgo (pertuzumab/trastuzumab/hyaluronidase-zzxf) | 9/18/25 | 11/2/25 | Pending | Phesgo (pertuzumab/trastuzumab/hyaluronidase-zzxf) |
| 2025-HB-MED-570 | Imfinzi (durvalumab) | 9/18/25 | 11/2/25 | Pending | Imfinzi (durvalumab) |
| 2025-HB-MED-571 | Zynyz (retifanlimab-dlwr) | 9/18/25 | 11/2/25 | Pending | Zynyz (retifanlimab-dlwr) |
| 2025-HB-MED-553 | Cosela (trilaciclib) | 9/18/25 | 11/2/25 | Pending | Cosela (trilaciclib) |
| 2025-HB-MED-554 | Trodelvy (sacituzumab govitecan) | 9/18/25 | 11/2/25 | Pending | Trodelvy (sacituzumab govitecan) |
| 2025-HB-MED-555 | Atezolizumab (Tecentriq, Tecentriq Hybreza) | 9/18/25 | 11/2/25 | Pending | Atezolizumab (Tecentriq, Tecentriq Hybreza) |
| 2025-HB-MED-556 | Doxorubicin Liposome (Doxil) | 9/18/25 | 11/2/25 | Pending | Doxorubicin Liposome (Doxil) |
| 2025-HB-MED-557 | Torisel (temsirolimus) | 9/18/25 | 11/2/25 | Pending | Torisel (temsirolimus) |
| 2025-HB-MED-558 | Polivy (polatuzumab vedotin-piiq) | 9/18/25 | 11/2/25 | Pending | Polivy (polatuzumab vedotin-piiq) |
| 2025-HB-MED-559 | Adcetris (brentuximab vedotin) | 9/18/25 | 11/2/25 | Pending | Adcetris (brentuximab vedotin) |
| 2025-HB-MED-560 | Erbitux (cetuximab) | 9/18/25 | 11/2/25 | Pending | Erbitux (cetuximab) |
| 2025-HB-MED-561 | Vectibix (panitumumab) | 9/18/25 | 11/2/25 | Pending | Vectibix (panitumumab) |
| 2025-LHCC-MED-854 | Burosumab-twza (Crysvita) | 9/17/25 | 11/1/25 | Pending | Burosumab-twza (Crysvita) |
| 2025-LHCC-MED-855 | Deferoxamine (Desferal) | 9/17/25 | 11/1/25 | Pending | Deferoxamine (Desferal) |
| 2025-LHCC-MED-856 | Aflibercept (Eylea, Eylea HD, Opuviz, Yesafili, Ahzantive, Enzeevu, Pavblu) | 9/17/25 | 11/1/25 | Pending | Aflibercept (Eylea, Eylea HD, Opuviz, Yesafili, Ahzantive, Enzeevu, Pavblu) |
| 2025-LHCC-MED-857 | Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo) | 9/17/25 | 11/1/25 | Pending | Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo) |
| 2025-LHCC-MED-858 | Lutetium Lu 177 Dotatate (Lutathera) | 9/17/25 | 11/1/25 | Pending | Lutetium Lu 177 Dotatate (Lutathera) |
| 2025-LHCC-MED-859 | Metreleptin (Myalept) | 9/17/25 | 11/1/25 | Pending | Metreleptin (Myalept) |
| 2025-LHCC-MED-860 | Polatuzumab Vedotin-piiq (Polivy) | 9/17/25 | 11/1/25 | Pending | Polatuzumab Vedotin-piiq (Polivy) |
| 2025-LHCC-MED-861 | Mitomycin for Pyelocalyceal Solution (Jelmyto) | 9/17/25 | 11/1/25 | Pending | Mitomycin for Pyelocalyceal Solution (Jelmyto) |
| 2025-LHCC-MED-862 | Pegcetacoplan (Empaveli, Syfovre) | 9/17/25 | 11/1/25 | Pending | Pegcetacoplan (Empaveli, Syfovre) |
| 2025-LHCC-MED-863 | Epcoritamab-bysp (Epkinly) | 9/17/25 | 11/1/25 | Pending | Epcoritamab-bysp (Epkinly) |
| 2025-LHCC-MED-864 | Glofitamab-gxbm (Columvi) | 9/17/25 | 11/1/25 | Pending | Glofitamab-gxbm (Columvi) |
| 2025-LHCC-MED-865 | Telisotuzumab Vedotin-tllv (Emrelis) | 9/17/25 | 11/1/25 | Pending | Telisotuzumab Vedotin-tllv (Emrelis) |
| 2025-UHC-MED-255 | Gamifant-emapalumab | 9/17/25 | 11/1/25 | Pending | Gamifant-emapalumab |
| 2025-UHC-MED-256 | Complement inhibitors | 9/17/25 | 11/1/25 | Pending | Complement inhibitors |
| 2025-UHC-MED-257 | Maximum Dosage and Frequency | 9/17/25 | 11/1/25 | Pending | Maximum Dosage and Frequency |
| 2025-UHC-MED-258 | Oncology medication clinical coverage | 9/17/25 | 11/1/25 | Pending | Oncology medication clinical coverage |
| 2025-ACLA-MED-112 | Anti FGF23 Monoclonal Antibody | 9/17/25 | 11/1/25 | Pending | Anti FGF23 Monoclonal Antibody |
| 2025-ACLA-MED-113 | BCMA Directed CAR T-cell Therapy | 9/17/25 | 11/1/25 | Pending | BCMA Directed CAR T-cell Therapy |
| 2025-ACLA-MED-114 | Brineura | 9/17/25 | 11/1/25 | Pending | Brineura |
| 2025-ACLA-MED-115 | Complement Inhibitors | 9/17/25 | 11/1/25 | Pending | Complement Inhibitors |
| 2025-ACLA-MED-116 | Encelto | 9/17/25 | 11/1/25 | Pending | Encelto |
| 2025-ACLA-MED-117 | IGF1R Antagonists Thyroid Eye Disease | 9/17/25 | 11/1/25 | Pending | IGF1R Antagonists Thyroid Eye Disease |
| 2025-ACLA-MED-118 | Injectable Iron | 9/17/25 | 11/1/25 | Pending | Injectable Iron |
| 2025-ACLA-MED-119 | Myasthenia Gravis Agents | 9/17/25 | 11/1/25 | Pending | Myasthenia Gravis Agents |
| 2025-ACLA-MED-120 | Omisirge | 9/17/25 | 11/1/25 | Pending | Omisirge |
| 2025-ACLA-MED-121 | Enzyme Replacement Therapy for Fabry Disease | 9/17/25 | 11/1/25 | Pending | Enzyme Replacement Therapy for Fabry Disease |
| 2025-ACLA-MED-122 | Oncology | 9/17/25 | 11/1/25 | Pending | Oncology |
| 2025-ACLA-MED-123 | Qalsody | 9/17/25 | 11/1/25 | Pending | Qalsody |
| 2025-ACLA-MED-124 | Rituximab | 9/17/25 | 11/1/25 | Pending | Rituximab |
| 2025-ACLA-MED-125 | Specialty Drugs | 9/17/25 | 11/1/25 | Pending | Specialty Drugs |
| 2025-ACLA-MED-126 | VEGF Inhibitors for Ophthalmic Conditions | 9/17/25 | 11/1/25 | Pending | VEGF Inhibitors for Ophthalmic Conditions |
| 2025-PHARM-121 | Palivizumab Criteria | 9/2/25 | 10/17/25 | Pending | Palivizumab Criteria |
Managed Care Pharmacy and Medical Drug Policies
In accordance with La. R.S. 46:460.51, et seq., prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.
The following table contains the LDH and managed care organization pharmacy and medical drug policies that are open for public comment. To provide feedback, please complete this form. Refer to the links below the table for archived postings and public comments.
Related Info
- Previously posted for public comment
- Managed Care Pharmacy and Medical Drug Policies - Archive (2024)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2023)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2022)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2021 and prior)
- Public comments submitted